Membranous Nephropathy

Question 1

Definition

Answer 1

Most common cause for nephrotic syndrome
Deposition of IgG and components in the glomerular capillary Wall followed Boy synthesis of new basemant membrane around them
Rarely inflammatory response in the glomeruli of interstitium

Question 2

Primary MN

Answer 2

Kidney-Limited auto-immune disease and accounts for 80 % of cases
Immune complex mediated against podocyte surface antigen
M-Type phospholipase-A2-receptor 1 (PLA2R) 70-80%
Thrombospondin type 1 Domain-containing 7a (THSD7A) 2-5%
Neural epidermal grwoth factor like Protein 1 (NELL-1) 5-10%

Question 3

Secondary MN

Answer 3

In 20% of patients

Neoplasm: Carcinomas, especially solid organ (tumors of the lung, colon, breast, and kidney), leukemia, and non-Hodgkin lymphoma

Infections:Malaria, hepatitis B and C, secondary or congenital syphilis, leprosy

Drugs: Penicillamine, gold

Immunologic : Systemic lupus erythematosus, mixed connective tissue disease, thyroiditis, dermatitis herpetiformis, sarcoidosis

Post kidney transplant: Recurrent disease, de novo membranous nephropathy

Miscellaneous: Sickle cell anemia, bovine serum albumin in children

Question 4

Genes

Answer 4

Neutral Endopeptidase
Bovine Serum Albumin
M-type phospholipase a2 receptor
Thrombospondin Type 1 Domain containing 7a
(THSD7A)
Neural epidermal grwoth factor like protein 1
(NELL-1)
Semaphorin 3B
Exostosin 1&2

Question 5

Diagnosis

Answer 5

Kidney biopsy
Anti-PLA2R antibodies and anti-THSD7A antibody

Question 6

Treatment non-specific

Answer 6

Sofien restriction
RR reduction
ACE,ARBs inhibitors

Treatment of Secondary effects (nephrotic syndrome:elevated cholesterol, triglycerides,LDL; normal to low HDL) —> statine

Question 7

Immuno therapy

Answer 7

Rituximab, or cytoxic+ corticosteroids, or cyclosporine